'Poetry gave me a voice when depression bound my thoughts and dried up my throat': why a good book is still the best cure for the black dog

Whether it’s the rhythm of poetry or the catharsis of a novel, research shows that medicating with books really works. Rachel Kelly makes the case for prose over pills

One evening, when Ellie Bate was five, she was rushed to hospital with kidney failure. Her mother, the biographer Paula Byrne, faced every parent’s worst nightmare when she was told her daughter might not survive the night.

‘My world was turned upside down,’ Paula recalls when we meet at Worcester College, University of Oxford. (Her husband is Sir Jonathan Bate, the college’s provost and a Shakespeare scholar.)

‘My thoughts were racing. I needed something to take my mind off what was happening while Ellie was in the operating theatre, but there was nothing but old copies of Hello! in the hospital waiting room. Luckily, I had a poem in my bag.’

The poem was All Shall be Well, the lyrical prayer of Julian of Norwich. Paula repeated the poem’s soothing cadences like a mantra all through the night: ‘All shall be well, and all shall be well, and all manner of things shall be well.’

‘It very much sustained me,’ Paula says. ‘There was something important about holding on to the words when there were none. Someone else had given me the words I couldn’t find.’

Ellie survived the night, though has needed treatment ever since. At nine years old, she underwent a kidney transplant operation. She is now 16, six feet tall and a typical teenager.

Earlier this year, there was an article in the respected medical journal The Lancet on ‘Books Do Furnish a Mind’, which extolled the virtues of bibliotherapy

‘Touch wood, she’s doing really well. But we’ve spent an awful lot of time in doctors’ waiting rooms with other frazzled parents and children. It has been very stressful. I have spent my time thinking about what I can do to help other parents in similar situations, and those finding life hard.’

Overwhelmed by caring for Ellie and working too hard, Paula herself eventually fell ill. ‘The stress I was under led to terrible pain in my hands, but I ignored it for ages. When I eventually went to the doctor, he prescribed me a book.’

It was a book of haikus – three-line Japanese poems. The pain went away. Now an infeasibly young-looking 47, Paula appears well and rested, her frame petite and her dark hair glossy. She wears a jewelled cross: she is Catholic and many of her favourite poems have a spiritual element.

Eleven years after the crisis of Ellie’s kidney failure, that dark night has led to something much brighter. Paula has not only co-edited a book, Stressed Unstressed: Classic Poems to Ease the Mind, but also established ReLit, a bibliotherapy foundation, and set up an online course exploring the health benefits of literature.

The course, hosted by the University of Warwick, entitled Literature and Mental Health: Reading for Wellbeing, was set up with the help of Paula’s husband, together with Warwick Business School

Sir Ian McKellen, Stephen Fry and Melvyn Bragg have all endorsed it, explaining how literature has proved a salve in their lives. The course looks at stress, heartbreak, depression and bereavement through the lens of literature.

Here, I must declare an interest: in 2014, Black Rainbow, my memoir about how I used poetry to help overcome depression, was published. It is on the reading list recommended by ReLit.

Like Paula, I turned to literature and poetry in my darkest hour and still rely on some of our greatest writers to get me through what Sigmund Freud called ‘ordinary human unhappiness’.

Poets such as George Herbert and Emily Dickinson have provided me with a voice when depression bound my thoughts and dried up my throat. By requiring me to concentrate and unpick meaning and metaphor, they hold me in the moment, stopping me from worrying about the future or the past, and are a wonderful antidote to my fretful nature.

In my case, I am following a family tradition. For many years as a child, I thought an ‘Erle Stanley Gardner’ was a kind of medicine. Whenever my mother would take to her bed with flu, my father would say: ‘She’s curled up with an Erle Stanley Gardner.’ Naturally, I assumed the master detective writer was some sort of miraculous pill.

And so, in a way, it was. Books have always been our family’s main source of solace. My mother was brought up in Hampshire. Her family’s life revolved around riding outside and reading within. Every spare inch of the house was lined with books. Only convention stopped the family reading at meal times.

'Both my grandparents turned to literature to sustain them through the horrors of two world wars and the dramas of raising five children. My grandmother’s favourites included Leo Tolstoy and Jane Austen, while my grandfather maintained there was no upset that a dose of P G Wodehouse couldn’t put right.

'My grandparents wouldn’t have called the ancient practice of reading for therapeutic effect ‘bibliotherapy’, but the phrase is now commonplace. The first use of the term is usually dated to a jolly 1916 article in The Atlantic Monthly, which ran a feature entitled ‘A Literary Clinic’.

Since then a plethora of courses have flourished: from those run for prison inmates to charities such as the Reader Organisation and initiatives such as Alain de Botton’s School of Life, and Biblio, a website that aims to connect someone needing help with a ‘curator’ who will choose the right book for them. Three years ago Ella Berthoud and Susan Elderkin published their seminal The Novel Cure: An A-Z of Literary Remedies.

More and more of us are finding books a salve. Novelist Daisy Goodwin put it thus: ‘A year ago my house burnt down. The fire started at lunchtime, and I spent the rest of the day trying to get hold of essential things I might need. But that night, as I lay in an unfamiliar bed in my shop-smelling nightie, I realised I didn’t have the one thing I really needed: a book.

‘And not just any book. I needed one of the novels that used to live on a shelf by my bed, all of them guaranteed to distract, beguile and soothe me through whatever life had to throw at me.

‘But now I had nothing – what had I been thinking of while doing my emergency shop? I had forgotten that the right book was a lot more important to my peace of mind than a clean pair of knickers or a toothbrush.’

Daisy’s top choices uncannily echo those of my grandparents: Emma by Jane Austen; Right Ho, Jeeves by P G Wodehouse; Arabella by Georgette Heyer; The Pursuit Of Love by Nancy Mitford; The Eustace Diamonds by Anthony Trollope.

What seems to have changed is not just how many of us are being helped by books, but the new seriousness with which bibliotherapy is being taken. Earlier this year, there was an article in the respected medical journal The Lancet on ‘Books Do Furnish a Mind’, which extolled the virtues of bibliotherapy.

There has been a growing dissatisfaction with the one-size-fits-all ‘magic bullet’ approach to mental health, as well as the sometimes debilitating side-effects of medication. There is a feeling that we need to embrace a more holistic approach, including the arts

I’ve been pondering why. I think part of the reason is that there is finally a growing body of evidence that medicating with books works. One group of studies now seems to show that those who read a lot of fiction tend to be more adept at empathising with others.

A 2011 study based on MRI scans of participants, published in the Annual Review of Psychology, showed that when people read about a situation, they show activity in the same neurological areas as when they have that experience themselves. We draw on the same parts of the brain when we’re reading stories and trying to empathise with others.

A second study, published in 2013 in the journal Science, showed that reading fiction improved people’s results in tests for social perception and empathy. Books, it seems, can be the best kinds of friends, giving us a chance to rehearse for interactions in real life.

Or, as George Eliot put it: ‘Art is the nearest thing to life; it is a mode of amplifying experience and extending our contact with our fellow-men beyond the bounds of our personal lot.’ The novelist was rumoured to have overcome her grief at losing her life partner by reading with a young man, who went on to become her husband.

There is also my own anecdotal evidence, which suggests reading puts our brains into a pleasurable, calm state that I can most liken to meditation. I know this to be true when I read a consoling poem, and I have witnessed it in poetry groups I have run for mental health charities including Mind and Depression Alliance.

It’s something about the focus required that makes reading a poem a good way of being in the ‘flow’ – which in turn is one of the best ways to cultivate good mental health according to happiness tsar and London School of Economics professor Paul Dolan.

There’s something, too, about companionship on the page. A participant in one of my workshops, Tara Dudley Smith, said: ‘I felt less alone when I realised others had experienced what I had.’

But while I’m a believer in bibliotherapy, I have to acknowledge that many will recall bookworms who can seem antisocial, even indolent. Not everyone finds their sorrow beguiled by books. And many poets I’ve met seem far from content.

The safe thing to say is that we need more research in work in this area, as the Arts Council also believes. While reading and literature can help alleviate the symptoms of anxiety, we don’t altogether understand why or how this works, or what its limits are.

Such research is crucial, as I think the other reason for the rise of bibliotherapy is disillusionment with other more brutal and unsubtle approaches to mental illness.

Biographer Paula Byrne faced every parent's worst nightmare when she was told her daughter might not survive kidney failure

We need fresh answers, and if the NHS is to adopt these widely, we need more evidence.

There has been a growing dissatisfaction with the one-size-fits-all ‘magic bullet’ approach to mental health, as well as the sometimes debilitating side-effects of medication.

There is a feeling that we need to embrace a more holistic approach, including the arts and other elements of self-care such as nutrition, an important and growing field – what and how we eat really can make us happy.

In the late 1980s, Prozac was heralded as one such magic bullet. But now the Royal College of Psychiatrists says that only around 50 per cent of people are helped by antidepressants. The same is true of the go-to cure of the 1990s: talking therapies.

Following the government’s Improving Access to Psychological Therapies initiative in 2008, more than a million people had cognitive behavioural therapy on the NHS in 2013/14.

Now mindfulness is the fashionable answer, but once again it doesn’t help everyone and the backlash is growing daily. The success, last Christmas, of Ladybird’s spoof Book of Mindfulness, which mocks many of its tenets, is telling.

I think the future will see a much more nuanced attitude to promoting good mental health, combining a variety of approaches, including the arts – literature and poetry in particular – and an emphasis on mindfulness and nutrition.

While we all know that we need to go to the gym for a healthy body, I feel we will realise we need to look after our minds as much as our bodies. Enthusiasm for bibliotherapy can only grow as we take a more rounded approach to what can improve our states of mind, and as the evidence to support it strengthens, too. Who knows, one day you may even be given an Erle Stanley Gardner on prescription.

Walking on Sunshine: 52 Small Steps to Happiness by Rachel Kelly is published by Short Books, price £9.99*. Rachel’s new book about nutrition and mental health, The Happy Kitchen, will be published in January next year. For more information on Rachel’s work, follow her on Twitter @rachelkellynet or visit rachel-kelly.net.

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'Poetry gave me a voice when depression bound my thoughts and dried up my throat': why a good book is still the best cure for the black dog